AGE RELATED MACULAR DISEASE - August 2013
Early age related macular degeneration (AMD) is characterised by drusen (small and large) and focal pigmentary changes. Patients with early AMD but no distortion do NOT usually require referral, except for other reasons e.g. partial sight registration, LVA’s or cataract. These patients can be referred via the usual route (NOT fast track). However, patients may just require increased reading additions, advice on lighting, diet and to stop smoking. If appropriate. AREDS preparations should be recommended to patients with large drusen and / or pigmentary changes.
Late AMD can be divided in late dry and late wet AMD. The late dry AMD is geographic atrophy involving the fovea. The ’wet’ AMD is characterized by the development of new blood vessels beneath the retina (choroidal neovascularisation). The sub-classification is no longer relevant in Lucentis therapy. This requires urgent referral for consideration on Lucentis therapy (subject to referral guidelines).
Which patients to refer?
Use of this form is only for patients registered with GP’s in LAMBETH, SOUTHWARK,
LEWISHAM, BEXLEY, BROMELY & GREENWICH.
Patient’s symptoms are very important – a recent onset of symptoms such as distortion scotoma, shadow or patch in the central vision is more likely to represent wet AMD, than simply a gradual worsening, blurring or difficulty with vision which is more likely to be related to the dry form, or cataract etc. If the VA is unchanged, it is unlikely that the patient will have wet AMD.
Fluorescein angiography and OCT are the mainstay for the diagnosis of wet AMD, the Amsler grid has a significant high false positive rate and has limited value.
NICE FAD on Lucentis states that treatment should be available to patients who have a VA of 6/96 or better in the affected eye without permanent structural damage to the fovea.
Local Referral Guidelines for Wet AMD (urgent – 2 weeks to treatment)
Visual loss and VA in affected eye – 6/96 or better
Recent sudden onset of central distortion (usually less than 6 months)
Fundal appearance suggestive of choroidal neovascularisation, such as haemorrhages and exudation.
Patients should be advised that treatment may not appropriate in every case.
If VA <6/96 - non-urgent referral to local eye department for consideration of LVA assessment.
Referrals using either the fax reporting form or the wet amd rapid access referral form to include the following information:-
Patient’s details and telephone number
Affected eye and duration in weeks
Patient’s refraction and VA
Referring Optometrist or GP name and address

SOUTH EAST LONDON
NHS
WET AMD DIRECT
REFERRAL PATHWAY
URGENT FAX REFERRAL FORM for patients registered with GP’s in LAMBETH,
SOUTHWARK, LEWISHAM, BEXLEY, BROMLEY & GREENWICH.
Referral Guidelines: (one answer must be 'yes')
Visual loss and VA in affected eye – 6/96 or better
Recent sudden onset of central distortion (usually less than 6 months)
Fundal appearance suggestive of choroidal neovascularisation, such as haemorrhage, exudation
Patient’s name and address:
Optometrist/GP name and address:
Telephone Number:
R
L
Telephone Number:
Patient’s refraction & visual acuity
VA
VA
Which eye is affected and duration in weeks
Right/Left Duration of symptoms:
Past history of AMD in either eye Y / N weeks
N
N
FINDINGS:
In the AFFECTED EYE ONLY, presence of:
Macular haemorrhage (preretinal, retinal. subretinal)
Subretinal fluid
Exudate
Y / N
Y / N
Y / N
King’s College Hospital
Ophthalmology Dept
Denmark Hill, London SE5 9RS
FAX: 020 3299 3012
Tel: 020 3299 1522
Queen Mary’s Hospital
Ophthalmology Dept,
Frognal Avenue, Sidcup, Kent DA14 6LT
FAX: 020 8308 5430
Tel: 08452 707727 (call centre new appts)
Princess Royal University Hospital
Farnborough Common
Bromley BR6 8ND
FAX: 01689 863329
Tel: 01689 865779
St Thomas’ Hospital
Eye clinic, Ground Floor, South Wing
Lambeth Place Road, London SE1 7EH
FAX: 020 7188 4318
Tel: 020 7188 4329
Moorfields Eye Hospital - Retinal Treatment Unit
162 City Road
London EC1V 2PD
FAX 020 7566 2583
Tel: 020 7556 2311
Optometrist: Send original to GP for information
Patient will be contacted within 1 week. However, please give the patient the telephone number
to call the chosen centre should this not happen.